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IHS Health Education Program Mary.Wachacha@ihs.gov

The Documentation of Breastfeeding Education in the IHS to meet the Ten Steps to Successful Breastfeeding (What gets measured, gets done!). IHS Health Education Program Mary.Wachacha@ihs.gov. Breastfeeding Toolkit. Available at www.ihs.gov under Health Education Resources.

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IHS Health Education Program Mary.Wachacha@ihs.gov

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  1. The Documentation of Breastfeeding Education in the IHS to meet the Ten Steps to Successful Breastfeeding(What gets measured, gets done!) IHS Health Education Program Mary.Wachacha@ihs.gov

  2. Breastfeeding Toolkit • Available at www.ihs.gov under Health Education Resources

  3. Sample Breastfeeding Toolkit Topics Toolkit 20: Neonatal Jaundice Toolkit 25: Feeding choices: Formula Feeding Skills for your Baby Toolkit 26: Feeding choices: Helpline and Formula Feeding your Baby Toolkit 31: Non-pharmacologic pain relief childbirth exercises, relaxation, breathing Toolkit 34: The Importance of 24-Hour Rooming In Toolkit 1: The Ten Steps Hospitals Must Take to Be Baby Friendly Toolkit 2: PEPC Education Guidelines For Baby- Friendly Hospitals Toolkit 5: How to document and code breastfeeding education Toolkit 7: Benefits of breastfeeding Toolkit 8: Breastfeeding positions

  4. The IHS has a system to document Education for all I/T/U programs. • This system is called the IHS Patient Education Protocols And Codes (or PEPC) • All disciplines and Providers should be using this method of documentation and coding for breastfeeding education.

  5. PEPC (Patient Education Protocols - Codes)consists of 2 required fields: • PROTOCOLS – the written guidelines of what to teach during the education encounter; • CODES – the mnemonic code used on the PCC, PCC+ and in the EHR to document the education

  6. PEPC has 2 parts: Protocols and Codes BF-BB BENEFITS OF BREASTFEEDING OUTCOME: The parent/family will be able to identify benefits of breastfeeding. STANDARDS: Identify benefits for mother, including decreased risk of postpartum hemorrhage, enhanced uterine involution, decreased risk of breast cancer, delayed return of menses, improved postpartum weight loss, and bonding. If breastfeeding is not an option, other feeding choices are available. Refer to “FF - Formula Feeding". Identify benefits to the baby (e.g., increased IQ, improved bonding, easier to digest, decreased diarrhea). Identify risk reducing benefits to the baby (e.g., reduced risk of: type 1 and type 2 diabetes, obesity, food allergies, infections of mucosal membranes, and constipation). Code – The code to use to document the education that was provided. Protocols - What are the Protocols? Protocols are written guidelines for education. Protocols contain: Outcomes to be achieved through education Standards to be followed when educating

  7. Where are the Protocols/Codes? The FY 2012 Patient Education Protocols and Codes can be found at: www.ihs.gov

  8. Click on: Support Non-Medical Programs

  9. Under Education/Training: Click on Patient Education Protocols and Codes

  10. Volume I: “How to Use” PEPC Manual Volume II: is the actual PEPCs

  11. Volume I: How to Use the PEPCs

  12. Volume II Manual is the actual Protocols and Codes

  13. This PEPC booklet can be downloaded online from www.ihs.gov Or contact Mary Wachacha for printed copies. These booklets change every year.

  14. While the Breastfeeding Protocols and Codes are located at www.ihs.gov, they are also available in the Electronic Health Record (EHR) under the Wellness tab.

  15. Can we track Breastfeeding Education? All education provided to patients can be tracked Yes

  16. Clinical Reporting System (CRS)Patient Education ReportNational Data Warehouse (NDW) This Report was established in 2007Patient Education tracking is available at every facility/site that uses RPMS via Clinical Reporting System You can view your Breastfeeding Education statistics

  17. Clinical Reporting System (CRS) • A component of RPMS • Provides automated local, regional, and national tracking of clinical performance on demand • Benchmarks measures to industry standards (HEDIS, Healthy People 2020, etc.) • Ask your local IT/CAC to run a CRS Education Report

  18. Information contained in the CRS Education Report:

  19. Where does the data come from? From provider documentation

  20. Youare the key to documentation: If it isn’t documented, it isn’t done! How will your site “prove” that breastfeeding education is provided?

  21. Breastfeeding Data Sources: National Data Warehouse (RPMS) • Outpatient visits • Inpatient discharges • Behavioral Health PEPC codes Searches for “valid” PEPC breastfeeding topics/codes – locally developed codes are not counted (i.e., do not make-up your own codes!)

  22. How is your facility doing? Every Site that Uses RPMS can run the CRS Education ReportAsk your IT staff to run theCRS Education Report

  23. How do you documentPatient Education?

  24. Educational Assessments • JCAHO and other healthcare accrediting agencies require the documentation of education. • Included in those requirements, is the requirement that other factors that might impact a patient’s ability to understand their health care – must also be documented. • These are called Educational Assessments. • There are 2 Educational Assessments that can be documented in RPMS. • Learning Preferences • Barriers to Learning • Bottom Line: Regardless of your facility accreditation: Providing education is a part of good patient care.

  25. Educational Assessment:Learning Preference (Health Factor) – How do you prefer to learn new information? Assess once a year – document as a Health Factor

  26. Education AssessmentBarriers to Learning (Health Factor)Assess once a year – assess by observation.

  27. Education AssessmentBarriers to Learning (Health Factor)Assess once a year – assess by observation.

  28. Where to document Health Factors?

  29. Documenting Health Factors in the EHR

  30. Breastfeeding/Bottle Feeding

  31. You are almost ready to begin. Before you begin to provide education – you have one more step! Before providing education, you must determine if the patient is ready and willing to listen to the education. How does one determine this? You ask the patient! Ms. Smith, I am now going to talk to you about exercise and physical activity. Are you willing to listen to me for 5-8 minutes as we discuss the importance of exercise?

  32. Steps for Documenting Patient Education*7 Mandatory steps • *Readiness to Learn • *Disease state, illness, condition or system being addressed 3. *Specific education topic 4. *Level of patient/family understanding of the material 5. *Time spent by the provider who did the education 6. *Initials of the provider who did the education 7. *Goal setting 8. Comments

  33. Example: BF- - EAGR -

  34. Example: - EAGR - BF- EQ

  35. BF-EQ (from the Protocols) OUTCOME: The patient/family will understand the instructions for effective use of breast pumps and other breastfeeding equipment. STANDARDS: • Discuss resources for manual and hospital grade electric pumps, including hospital, clinic, WIC, and community. • Discuss and demonstrate effective use of pumps. • Emphasize the proper use and care and cleaning of equipment. • Discuss any other breastfeeding equipment as appropriate.

  36. Example: -EAGR- BF - EQ - G

  37. Levels of understanding

  38. Example: EAGR- BF - EQ - G - 15 min.

  39. Example: EAGR- BF - EQ - G - 15 min. -Your initials here

  40. EAGR- Example: BF - EQ - G - 15 min. - MW - GS: Pt. will BF 1st 6 months

  41. Goals – Set, Not Set, Met, or Not Met(Assisting the patient to change behavior) • State a plan • State a plan how to maintain at least one _____ • Write a plan of management • Plan to change ______ • A plan to test _____ (blood sugar) • Choose at least one change to follow _____ • Demonstrate ___ and state a personal plan for ____ • Identify a way to cope with ____

  42. Documenting Goal Setting in EHR

  43. EAGR- Example: BF - EQ - G - 15 min. - MW - GS: -Pt. will BF 1st 6 months Comment: Pt. concerned about returning to work.

  44. DM M G ABC-Time GS Disease State / Condition You can document the disease state in one of three ways: 1) Diabetes type 2 2) ICD-9 code: 250.xx 3) DM - from the patient & family education protocols. Common Disease States: CHF Congestive Heart Failure HTN Hypertension CAD Coronary Artery Disease LIP Dyslipidemia DM Diabetes PM Pain Management EYE Eye condition PL Pulmonary FP Family Planning TO Tobacco Use Education Topic Modifier What you talked about. There are 17 standard topics in the IHS Protocols. These include: AP - Anatomy and Physiology C - Complications DP - Disease Process EQ - Equipment EX - Exercise FU - Follow-up HM - Home Management LA - Lifestyle Adaptation HY - Hygiene L - Literature M - Medication N - Nutrition P - Prevention PRO - Procedures S - Safety TE - Testing TX – Treatment Level of Understanding Defines how well the patient/family understood the education. It does not reflect on your ability to teach it! G= good F= fair P= poor R= refused Gp= group education- unable to assess individually Taking Credit Use either your provider number or your initials to take credit for the education. It may also be important to place the length of time you spent educating the patient next to your initials for certain billing purposes Patient Goals GS = Goals set GM = Goals met GNM = Goals Not Met

  45. An example of documented Education in the EHR

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